FEASIBILITY AND CLINICAL UTILITY OF STONE EXTRACTION BALLOON CATHETER-ASSISTED ENDOSCOPIC STENTING FOR MALIGNANT DISTAL DUODENAL AND PROXIMAL JEJUNAL OBSTRUCTION

Background: Endoscopic stenting for malignant distal duodenal and jejunal obstructions is challenging because the length of conventional gastroscopes is insufficient to reach the obstruction point. A stone extraction balloon catheter fully inflated after being introduced through the endoscope’s working channel can freely navigate the duodenum and jejunum without causing bowel injury by burying the catheter tip. It can easily change its direction for guidewire relocation, conforming to angulation of the small bowel flexure. This study evaluated the feasibility and efficacy of stone extraction balloon catheter-assisted endoscopic stenting for malignant distal duodenal and proximal jejunal obstructions.
Methods: Patients with malignant distal duodenal or jejunal obstruction who underwent stone extraction balloon catheter-assisted distal duodenal and proximal jejunal stenting between January 2015 and December 2022 were retrospectively analyzed.
Results: We enrolled 30 patients in this study. Pancreatic cancer was the primary cause of duodenal obstruction, with the third portion of the duodenum being the most common site of obstruction. Technical success was achieved in 100%, and the clinical success rate was 100%. The median procedure time was 35 minutes, and the mean gastric outlet obstruction score (GOOSS) improved from 1.20 (pre-procedure) to 2.87 (post-procedure). Early stent migration was encountered in one patient. During follow-up, stent dysfunction was noted in nine (30%) patients, and overall stent patency time was 145 days.
Conclusions: Stone extraction balloon catheter-assisted endoscopic stenting is an effective and reproducible technique for treating malignant distal duodenal and jejunal obstructions.